Perinatal outcomes of isolated non-visualization of the fetal gallbladder

Aims: This study aimed to evaluate perinatal outcomes in pregnancies with isolated non-visualization of the fetal gallbladder (NVFGB) identified during second-trimester anatomical screening. Methods: This retrospective cohort study included 22 pregnancies diagnosed with isolated NVFGB between November 2022 and January 2025 at a tertiary maternal–fetal medicine unit. Cases with additional structural anomalies, multiple gestations, or elective terminations were excluded. Maternal demographics, antenatal ultrasound findings, and neonatal outcomes were reviewed. Postnatal imaging and clinical follow-up were evaluated for gallbladder visualization and underlying pathology. Results: In half of the included cases (11/22), the gallbladder was visualized either on follow-up scans or after birth. Among the remaining 11 cases, two had midline-located gallbladders on postnatal imaging, one of which required surgical correction for intestinal malrotation. Two fetuses were prenatally diagnosed with cystic fibrosis, including one complicated by meconium peritonitis requiring surgery. Two additional cases were diagnosed postnatally with biliary atresia and underwent hepatoportoenterostomy. Chromosomal microarray analysis (CMA) was performed in ten cases; no anomalies were identified aside from cystic fibrosis. Overall, five cases (23%) were associated with significant postnatal diagnoses requiring medical or surgical intervention. Conclusion: Although isolated NVFGB is often a benign and transient finding, it may occasionally indicate serious underlying conditions such as biliary atresia or cystic fibrosis. Detailed follow-up, repeat imaging in late gestation, and thorough postnatal evaluation are essential for appropriate diagnosis and management.